Organization Name: | BEACHSIDE RECOVERY LLC |
NPI Number: | 1710365598 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DARRYLE MACKELVEY (SUPERVISOR) |
Mailing Address: | 16812 Red Hill Ave Ste A Irvine |
State: | CA US |
Postal Code: | 926064844 |
Phone Number: | 9493934070 |
Fax Number: | |
NPI Enumeration Date: | 05/12/2015 |
NPI Last Update Date: | 05/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | 300315BP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |